CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 42.9200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 15.8400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
Subtotal (Total Children Is Unduplicated) 6 11.000000 265.9100 24.1736
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.000000 47.3500 47.3500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 342.500000 18199.0000 53.1358
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 48.000000 2548.0000 53.0833
OCCT-97530-OT SESSION BY LICENSED OT 7 63.500000 3561.6300 56.0887
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 7.750000 306.5600 39.5561
OCCT-97530GT-OT SESSION BY LICENSED OT 6 85.500000 5931.2600 69.3715
OCCT-97530HM-OT SESSION BY OT ASST 2 21.500000 1291.1200 60.0521
OCCT-97530HMGT-OT SESSION BY OT ASST 3 23.250000 1457.6100 62.6929
PHY-97110-PT SESSION BY LICENSED PT 17 480.250000 33654.5800 70.0772
PHY-97110GT-PT SESSION BY LICENSED PT 6 39.250000 2407.7300 61.3434
PHY-97110HM-PT SESSION BY PT ASST 8 100.500000 5805.7200 57.7684
PHY-97110HMGT-PT SESSION BY PT ASST 3 19.750000 803.2800 40.6724
SENS-V5264-EARMOLD 4 9.000000 163.1700 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 469.500000 34538.0200 73.5634
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 25 225.000000 16735.0700 74.3781
Subtotal (Total Children Is Unduplicated) 102 1938.250000 127594.0200 65.8295
-----------------------------------------------------------------------------------------------------------------------
Total 1949.250000 127859.9300 65.5944
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 104
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1505 1411.250000 91738.3000 91738.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
619 538.000000 36121.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2124 1949.250000 127859.9300 91738.3000